Minimally invasive knee surgery: a guide

Minimally invasive surgery is a technique that can be used on the knees, the largest joint of the body. In this article, a consultant orthopaedic surgeon explains the applications of minimally invasive knee surgery.

 

 

When do the knees require surgery?

The knees are made up of the patella bones and the ends of the tibia and femur (shin and thigh) bones. All around them is a network of ligaments, tendons, and cartilage. These all work together to make the knee stable and strong, but because use our knees so much, they can be quite susceptible to damage that necessitates surgery to address or treat the issue. Knee dysfunction can happen suddenly, or develop over time as a result of wear-and-tear.

Common issues and conditions that can interfere with the function of the knee include:

• Arthritis, which is when the joint becomes inflamed due to a loss of the articular cartilage. Common kinds of arthritis are osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis.
• Ligament tears, e.g. an ACL tear, which can occur when the knee twists or bends abnormally.
• Runner’s knee, which is an inflammation of the patellar tendon and is common in athletes.
• Bursitis, which is inflammation of fluid-filled sacs near the joint that become inflamed due to constant strain and repetitive movement on the knees, and commonly occurs Jumper’s knee, which is small tears in the patellar tendon that can occur due to activities that require a lot of jumping.
• Meniscus tears, where the meniscus cartilage that cushions the knees tears and causes the ends of the tibia and the femur to rub together.
• Fractures of the bones, from injury and accidents like car collisions or falling.

 

To treat knee injuries and dysfunction, a knee arthroscopy is likely to be performed. A knee arthroscopy is a minimally invasive surgery where small incisions are made along and around the knee, and through which a surgeon can insert fine surgical tools, one such being the arthroscope, a long thin tube with a a camera and light at the end. Using the arthroscope, they are able look around the knee and assess the damage with the camera’s perspective being projected to a screen nearby in the operating theatre. Knee arthroscopies can be used a diagnostic procedure, or as part of the treatment process.

During knee arthroscopy, the patient is under a general anaesthetic, and typically, knee arthroscopy can be performed in a couple of hours, meaning that the patient can be up walking about and go home within the same day (this can vary depending on the reason for the surgery).

Several types of procedures can be performed on the knee arthroscopically, such as knee replacements (partial, total, and revisional), torn cartilage trimming, tendon repair and grafts, putting the bones in place after a dislocation, shaving down bone spurs, and ligament reconstruction.   

 

What are the benefits of minimally invasive knee surgery?

Traditional surgery incisions are large and can take a long time to heal, leave a highly visible scar on the leg, and can lead to a lot of blood loss during the procedure. The benefits of keyhole surgery are that the incisions are smaller, meaning there is less blood loss, shorter recovery time, and smaller, less noticeable scars. Additionally, patients will have less pain and swelling, and can return to work or school very soon after the procedure. Keyhole procedures tend to be on the short side, ranging from 30 minutes to four hours, but this will depend on the nature of the procedure.

Recovery time can range from a month to eight months, again depending on the nature of the surgery. Walking and normal activities can resume very soon, within a couple of weeks, but extreme contact sports and physical activity will not be recommended until after six months. Patients are advised to undergo physical therapy, which will teach them stretches and exercises to strengthen the knee and regain mobility and stability.